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BACKGROUND: The clinical features of central nervous system (CNS) sporotrichosis are derived from case reports and a limited series of cases. Our objective was to carry out a systematic review and meta-analysis of CNS sporotrichosis. METHODS: We searched PubMed/MEDLINE, Embase, Scopus, and LILACS on 9 September 2023. Our inclusion criteria were documentation of Sporothrix and demonstrated CNS involvement. A metaproportion or metamean analysis was performed to estimate a summary proportion with 95% confidence intervals. RESULTS: We included 52 cases of CNS sporotrichosis published from 1966 to 2023. Forty-six patients were male (88%, 95% CI: 77-95), and the mean age was 39 years (95% CI: 36-43). Close contact with cats was reported in 55% of cases (95% CI: 37-72). Thirty-two (61.5%) patients were from Brazil, 18 patients from the United State of America (34.6%). Only two Sporothrix species were reported: S. schenckii (26/41, 63%), and S. brasiliensis (15/41, 37%). The most common neurological symptom was headache. Meningitis was chronic in approximately 80% of cases. A significant majority of the patients were immunocompromised. HIV infection was the primary cause of immunosuppression (85%, 95% CI: 61-95). Overall mortality was 56% (22/39). The comparison of Kaplan-Meier survival curve showed a higher mortality with a statistically significant difference in immunosuppressed patients (p = .019). CONCLUSION: CNS sporotrichosis represents a notable cause of chronic meningitis, especially in individuals living in the Americas with HIV infection and concurrent skin lesions.

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In Mexico, tattooed migrants face discrimination and are at high-risk of incarceration, thus, we assessed whether receiving laser tattoo removal affected the likelihood of incarceration. In 2015-2016, 89 adults ages ≥ 18 years with visible tattoos were recruited at a free-clinic to receive laser tattoo removal or assigned to the wait-list; all completed baseline and 6-month questionnaires. Overall, 97.8% of participants ever migrated to the USA. In multivariate analyses restricted to migrants (n = 87), those receiving laser tattoo removal [Adjusted Odds Ratio (AOR) 0.27, 95% CI 0.07-0.89] and possessing a Mexican Voting card (AOR 0.14; 95% CI 0.03-0.58) were significantly less likely than wait-list participants to be incarcerated at 6-months. Previously incarcerated participants were significantly more likely to be incarcerated at follow-up. Tattoo removal may reduce incarceration among Mexican migrants. Future studies can assess other health and social benefits of tattoo removal for migrants/deportees returning to Mexico.

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CONTEXT: Physical, sexual, and emotional abuse in childhood-adverse childhood experiences (ACEs)-are associated with poor mental and physical health. OBJECTIVE: To determine the prevalence of ACEs and their relationship to depression among Latino migrants in Mexico, which has not been previously examined. METHODS: A total of 110 Latinos aged 18 years and older residing in Tijuana, Mexico, completed interviewer-administered questionnaires, including the ACE scale (range = 0 to 10 items), at baseline in 2015. We studied the prevalence of ACEs (score on the ACE scale) and the presence of depressive symptoms (Patient Health Questionnaire-9). Multivariate logistic regression models were used to estimate the association between the ACE score and depressive symptoms. RESULTS: Overall, 82% of participants were men, and 82% reported being deported from the US. At least 1 ACE was reported by 64% of participants, and 33% reported 3 or more ACEs. Those who reported ever being incarcerated were significantly more likely to have 3 or more ACEs compared with no ACEs (56% vs 28%; p = 0.039). Symptoms of mild, moderate, or severe depression were identified in 14% of participants. In multivariate analyses, for each additional ACE item reported, participants were significantly more likely to meet criteria for depressive symptoms (adjusted odds ratio = 1.42; 95% confidence interval = 1.13-1.78; p = 0.002). CONCLUSION: Among Latino migrants residing in the US-Mexico border region, ACEs were pervasive and associated with depression symptoms. Programs and policies targeting migrants in this region should consider addressing both ACEs and depression.

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INTRODUCCION: En Argentina, hay insuficientes médicos que eligen formarse en residencias de Medicina General o Familiar. Además, una proporción importante tiende a abandonar la práctica después de la formación. OBJETIVOS: Identificar lasrazones que llevan a elegir la Medicina General por sobre otras alternativas de formación en las residencias nacionales. Explorar los factores que motivan el abandono de la Medicina General porparte de los profesionales ya formados. METODOS: Se realizó un estudio descriptivo de corte transversal, con combinación de técnicas cuantitativas y cualitativas implementadas sobre dos poblaciones: a) la que había efectuado la preinscripción para residencias nacionales en 2012 y b) los médicos que habían iniciado sus residencias enMedicina General o Familiar entre 2001 y 2004, teniendo siempre en cuenta las provincias de Jujuy, Tucumán, Santa Fe y Neuquén. RESULTADOS: Los preinscriptos que habían optado por la Medicina General esgrimieron principalmente cuestiones relacionadas con lo comunitario y el compromiso social. Se mostraron menos preocupados por el prestigio social y por el bienestar económico. Sin embargo, después de unos años de práctica, la baja valoración económica y simbólica de la especialidad, las condiciones de trabajo y el techo en el desarrollo profesional fomentaron la emigración hacia otra actividad. CONCLUSIONES: El estudio provee recomendaciones para diseñar y monitorear políticas destinadas a reforzar la eleccióny permanencia de los médicos generalistas en la práctica. Estocomprende el pregrado en las universidades y el mercado de trabajoen las respectivas jurisdicciones.

INTRODUCTION: Argentina has a lack of physicians who choose to be trained in General or Family Medicine residencies. In addition, a significant proportion tends to leave the practice after training. OBJECTIVES: To identify the reasons that lead physicians to choose General Medicine instead of other training possibilities in national residencies. To explore the factors that lead trained professionals to quit practicing General Medicine. METHODS: A descriptive, cross-sectional study was performed. It used a combination of quantitative and qualitative techniques implemented on two populations:(a) the population that had pre-registered for residencies in 2012, and (b) physicians who had started their residencies in General or Family Medicine from 2001 to 2004, considering the provinces of Jujuy, Tucumán, Santa Fe and Neuquén. RESULTS: The professionals who had chosen General Medicine mainly based their decisions on issues related to community and social commitment, while social prestige and economic welfare were not as important. However, after a few years of practice, the low economic and symbolic value of the specialty, the poor working conditions and the limited professional development opportunities led them to migrate to another activity. CONCLUSIONS: The study provides recommendations for the design and monitoring of policies, which are useful to strengthen the choice and permanence of general practitioners in their activity. This involves undergraduate university programs andlabor market in the respective jurisdictions.

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Argentina comparte con otros países el problema de la insuficiencia de médicos que elijen programas de medicina general y/o familiar en función de las necesidades de cobertura. A esto se agrega que una proporción importante de ellos abandonaría la práctica asistencial específica después de la formación. El presente es un estudio multicéntrico, descriptivo de corte transversal, con combinación de técnicas cuantitativas y cualitativas implementadas sobre dos poblaciones. La primera es la población de médicos que realizan la preinscripción para aplicar a residencias nacionales a partir del año 2012. La segunda población es la de médicos que iniciaron sus residencias en medicina general o familiar entre los años 2001 a 2004. El ámbito de estudio son las provincias de Santa Fe, Jujuy, Tucumán y Neuquén Los objetivos de este estudio fueron establecer hipótesis en torno a a) la elección de un programa de formación en medicina general y/o familiar al momento de la preinscripción b) la permanencia o abandono de la práctica asistencial de la medicina general. Los hallazgos de esta investigación reflejan un perfil particular de quienes seleccionan la especialidad desde la preinscripción, con mayor interés por lo social y comunitario, y menos por el prestigio social y el bienestar económico. Sin embargo, las entrevistas realizadas a los egresados muestran que factores como la valoración económica y las características de los espacios de trabajo resultan asociados al abandono de la práctica. El estudio provee recomendaciones para el diseño y monitoreo de políticas destinadas a reforzar la elección y permanencia de los médicos generalistas en la práctica. (AU)

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